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PubMed2007

Monitoring a national cancer prevention program: successful changes in cervical cancer screening in the Netherlands.

The success of screening, an important cancer prevention tool, depends on the quality and efficiency of protocols and guidelines for screening and follow-up. However, even centrally organized screening programs such as the Dutch cervical screening program occasionally show problems in performance. To improve this program, the screening scheme, follow-up, administration and financing protocols and guidelines were thoroughly changed in 1996. This study evaluates the consequences for the performance of the national program. Five-year coverage rate, the proportion of screened women sent to follow-up, follow-up compliance and duration, and the yearly number of Pap smears before and after the changes in 1996 were compared. Five-year coverage increased substantially in the added target age groups (30-34, and 54-60 years); in the old target age group (35-53 years) it remained around 80%. The percentage of screened women sent to follow-up decreased from almost 19-3% per screening round, due to a more restrictive use of the Pap 2 classification, and an evidence-based cessation of follow-up of negative smears without endocervical cells. Follow-up compliance has improved, and the average time until a woman is either referred or rejoins the regular screening schedule, has become shorter. The total number of smears, a strong determinant of screening costs, has decreased by 20% primarily due to the changed follow-up recommendations. In conclusion, the 1996 changes in protocols and guidelines, and their implementation have increased coverage and efficiency, and decreased the screening-induced negative side effects.

Adult↗
PubMedDate not supplied

Impedance screening. An integral part of hearing screening.

Rationale is presented for including tympanometry as an integral part of all hearing screening programs. Impedance screening will yield more accurate screening results in the identification of middle ear disease than traditional hearing testing or otoscopic examination. Medical complications often result from unidentified otitis media which also contributes to speech, language, and educational delays in children. Although additional research information is needed on the significance of early identification of children with otitis media, it is argued that tympanometry will foster such research efforts, while providing improved identification and potential management of middle ear disease in screening programs.

Acoustic Impedance Tests↗
PubMed2002

Quality assurance in follow-up and initial treatment for screening mammography programs in 22 countries.

OBJECTIVE: To describe the quality assurance activities related to follow-up evaluation of abnormal screening mammograms and subsequent initial treatment of women determined to have breast cancer for the screening programs represented in the International Breast Cancer Screening Network (IBSN). DESIGN: Analysis of data from a survey that included questions about screening program policies, standards, and procedures for follow-up of women with abnormal mammograms, as well as the data and measures that programs use to assess the adequacy of follow-up and initial treatment. SETTING AND PARTICIPANTS: IBSN representatives in 23 countries completed a comprehensive questionnaire between May and December 1998. RESULTS: Two-thirds of IBSN countries reported that they have a written policy or guidelines for follow-up of an abnormal mammogram; 64% require accreditation of the cytology or pathology laboratories that analyze breast specimens, or subject pathology laboratories to external audits. Of the 22 activities and measures related to quality of follow-up and initial treatment that we examined, all countries had in place at least half of them, although countries were more likely to have implemented activities and measures related to data collection and evaluation than to processes of care. CONCLUSIONS: Population-based screening mammography programs cannot achieve the goal of reducing breast cancer mortality if women with abnormal mammograms do not receive appropriate, timely follow-up and initial treatment. This study shows that IBSN countries vary in their implementation of procedures and measures to assure the quality of follow-up and initial treatment for women with abnormal screening mammograms. There is more emphasis on collecting and evaluating data than establishing mechanisms to ensure that the processes of care for follow-up and initial treatment are of high quality.

Breast Neoplasms↗
PubMed2006

Comprehensive cost-utility analysis of newborn screening strategies.

BACKGROUND: Inborn errors of metabolism are a significant cause of morbidity and death among children. Inconsistencies in how individual states arrive at screening strategies, however, lead to marked variations in testing between states. OBJECTIVE: To determine the cost-effectiveness of each component test of a multitest newborn screening program, including screening for phenylketonuria, congenital adrenal hyperplasia, congenital hypothyroidism, biotinidase deficiency, maple syrup urine disease, galactosemia, homocystinuria, and medium-chain acyl-CoA dehydrogenase deficiency. METHODS: A decision model was used, with cohort studies, government reports, secondary analyses, and other sources. Discounted costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios were measured. RESULTS: All except 2 screening tests dominated the "no-test" strategy. The 2 exceptions were screening for congenital adrenal hyperplasia, which cost slightly more than $20,000 per QALY gained, and screening for galactosemia, which cost $94,000 per QALY gained. The screening test with the lowest expected cost was tandem mass spectrometry. The results found in our base-case analysis were stable across variations in nearly all variables. In instances in which changes in risks, sequelae, costs, or utilities did affect our results, the variation from base-case estimates was quite large. CONCLUSIONS: Newborn screening seems to be one of the rare health care interventions that is beneficial to patients and, in many cases, cost saving. Over the long term, funding comprehensive newborn screening programs is likely to save money for society.

Cost-Benefit Analysis↗
PubMed1994

Seroepidemiologic screening of Echinococcus multilocularis infection in a European area endemic for alveolar echinococcosis.

In a serologic survey for Echinococcus multilocularis infection, we screened sera from 7,884 subjects from the Doubs Departement in France, an area endemic for alveolar echinococcosis (AE) of the liver. An enzyme-linked immunosorbent assay (ELISA) with a highly species-specific antigen (Em2) and an E. multilocularis crude antigen (Emc) was used for screening. An evaluation of the cost/benefit relationship of this screening, followed by therapeutic management of patients, was made and compared with the actual cost of the follow-up and treatment of the disease in symptomatic cases in this endemic area. Antibody reactions to Em2 and/or Emc made possible the detection of eight asymptomatic clinical cases (seroprevalence averaging 1/1,000), with typical lesions of active AE revealed by abdominal ultrasonography and computed tomography. All were seropositive using the Emc ELISA but two were seronegative using the Em2 ELISA. In five additional seropositive cases, the radiologic investigations revealed small calcified lesions similar to the lesions of abortive AE previously found in Alaska. The cost of this serologic screening program per screened subject and per diagnosed case averaged 50.00 French Francs (FF) (U.S. $8.60) and 60,000.00 FF (U.S. $10,909.00), respectively. The cost of diagnosis, follow-up and treatment of the patients was 5,086.00 FF (U.S. $929.00) per patient per month in the case of diseases diagnosed by the screening program and 7,086.00 FF (U.S. $1,288.00) per patient per month for patients with symptomatic AE. This survey indicates a high prevalence of AE in the target area; it confirms the long latency period of the larval growth in human AE and shows that abortive AE is present in Europe. The use of both the Emc and Em2 ELISAs seems to be better than using the Em2 ELISA alone. The cost of the hospitalization and treatment of the eight screened patients would appear to be relatively high. Even though two of them were asymptomatic, they had very severe forms of the disease. In fact, the total cost was much lower than the actual cost of the disease when diagnosed from clinical symptoms.

Adolescent↗
PubMed1982

Age at time of first intercourse v. chronologic age as a basis for Pap smear screening.

The Walton Report on cervical cancer screening programs recently recommended a new program for screening for cervical cancer based on chronologic age, calling for 3- and 5-year intervals between examinations. It recommended that such examinations be discontinued after 60 years of age. In a group of 232 routinely examined women (aged 18 to 47 years) in whom cervical intraepithelial neoplasia developed the timing of onset of the disease and the implications for screening were studied. The average age at the time of diagnosis was 30 years; in 20% of the patients the diagnosis had been made after age 35. The screening program recommended in the Walton Report would have been effective in diagnosing most cases (80%) in this sample by age 35 and all by age 60. However, when the patients were grouped according to age at the time of first intercourse, the diagnosis had been made after age 35 in only 13% of those who started having intercourse at age 15 to 17 years, 20% of those who started at age 18 to 19 years and 33% of those who started at age 20 years of later. When the times of diagnosis were expressed by number of years of intercourse the distributions became uniform in the same three groups; in 72% of all the patients the diagnosis had been made within the first 15 years of intercourse, in 88% it had been made within 20 years and in 100% it had been made by 30 years. These data suggest that a program based on number of years of intercourse may be more uniform and more efficient than one based on chronologic age, and that cytologic examinations should be concentrated during the time when most cases develop -- 6 to 20 years after the time of first intercourse.

Adolescent↗
PubMed1996

The genetic basis of colorectal cancer risk.

The genetic understanding of colon cancer susceptibility is advancing very rapidly; it has already had a major impact on clinical management, and we have only seen the beginning. Genes responsible for the two well-defined familial colon cancer syndromes (APC and HNPCC) have been identified. These syndromes can now often be diagnosed by genetic rather than by endoscopic screening of the at-risk individuals in a family. Linkage analysis, although clinically cumbersome, can be performed for families with both APC and HNPCC. In some families, the mutation itself can be determined and a specific mutation assay can be used in the other at-risk members of the family. Both linkage analysis and mutational assays are still largely performed in specialized high-risk cancer clinics. For APC, a truncated protein assay performed on cells isolated from peripheral blood is now commercially available, so the genetic diagnosis of APC can be made by any clinician. It is important, however, to be able to provide appropriate genetic counseling to families before and after genetic testing for these familial colon cancer syndromes. The familial clustering of "sporadic" colon cancer has been suggested to be due to the inheritance of a susceptibility gene or genes. A family history of colon cancer has become an important stratification criteria for colon cancer screening programs. Colonoscopic screening is indicated for individuals with two or more FDRs with colon cancer or with one FDR in whom colon cancer developed under the age of 50 or so. If specific susceptibility genes for sporadic colon cancer are identified, it will be possible to target powerful primary preventive and screening programs to this high-risk population (susceptibility gene carriers).

Colorectal Neoplasms↗
PubMedDate not supplied

Screening for abuse during pregnancy: implementing a multisite program.

Screening for abuse at every healthcare visit is a standard of practice promulgated by many healthcare professional organizations. The need for such screening is underscored by reports of homicide as a leading cause of maternal mortality during pregnancy and the first year of the baby's life in Massachusetts and Maryland, and by the calculation of the costs of intimate partner violence in the United States. This article discusses how we addressed problems that arose in implementing screening for abuse in 13 different sites as a part of a clinical nursing research project. Engaging in clinical nursing research necessitates close relationships with clinical agencies and their staff members. This often means establishing and maintaining relationships with all nurses caring for patients in each clinical unit serving as a study site. For research on abuse during pregnancy, our study team members were engaged in interactions with prenatal care providers at 13 different study sites. Central to the study was implementing use of a standardized abuse screening tool, the Abuse Assessment Screen, at each study site. This article also describes the lessons we learned in attempting to implement such a large scale change in clinical practice.

Adult↗
PubMed2004

Vision health care providers' attitudes and experiences with preschool vision screening in Ontario.

PURPOSE: The validity of preschool vision screening has been questioned in the light of the World Health Organization's criteria for determining the validity of screening programs. However, recommendations toward preschool screening have been made by a number of organizations. Given the contrasting views of screening, the purpose of this study was to examine visual health care provider experiences and attitudes toward preschool screening. METHOD: Optometrists, public health administrators, pediatric ophthalmologists, and orthoptists were surveyed about opinions of, recommendations for, and experiences with preschool vision screening in Ontario. The survey focused on four areas, including general opinion of preschool screening, screening standards and practices, provider experience with preschool screening, and barriers to preschool screening. In addition, survey responses were broken down by regional access to health care. RESULTS: Overall, strong support for preschool vision screening and movement toward standardization of screening practice was found among all surveyed groups. Although support for vision screening in low health care access areas was strong, providers estimated that parent compliance to screening was weaker in low access areas. Providers also reported considerable variability in vision screening practices. In addition, although the majority of providers had been involved in a screening program, the majority was no longer involved because of lack of program organization, structure, and funding. Lack of sufficient funding, public education, organization of screening, training, and government support were listed as barriers to preschool vision screening. CONCLUSION: Providers are interested in the development of structured screening programs. However, although screening may be a way to offer some level of vision care service to low health care access areas, a number of factors need to be addressed in discussions of vision screening program standards or screening best practice. In general, preschool screening programs need to be structured, be supported, have quality control, and be evaluated.

Attitude of Health Personnel↗
PubMed1999

Receptivity of a worksite breast cancer screening education program.

A breast cancer screening education program was offered to 97 major worksites in Forsyth County, North Carolina. Worksites could design a program by choosing components that consisted of (1) brochures, (2) breast cancer education classes taught by program staff or (3) sending company nurses to be trained by program staff to then teach employees at the worksite. A total of 63 out of the original 97 companies (65%) accepted and offered a program to their employees. Worksites that chose to sponsor a program were more likely to have already sponsored breast cancer education programs at their worksites (P = 0.027) or to have a medical department (P = 0.006). The type of component selected was significantly associated with a history of sponsoring other health education programs (P < 0.001). Fourteen worksites chose the more intensive component, the training of a company nurse. More than half of the worksites that had never sponsored and had no plans to sponsor worksite breast education programs were receptive to our program (43 of 73, 59%). The majority of these sites (67%) chose the brochure. These results indicate that worksites are receptive to offering breast cancer educational programs if varying types of components can be selected.

Adult↗
PubMed1995

Detection of latent prostate cancer from routine screening: comparison with breast cancer screening.

OBJECTIVES: One criticism of routine prostate cancer screening is the possibility that latent prostate cancer would be detected and treated in men who would otherwise never need treatment for their prostate cancer. This increase in latent cancer detection with screening could lead to overtreatment, with its resulting increases in morbidity, mortality, and health care costs. In contrast, breast cancer screening is widely accepted, and there is little concern about latent breast cancer detection and overtreatment of breast cancer due to screening. This study compares the detection of latent prostate cancer from screening with the detection of latent cancer in an established cancer screening program (breast cancer screening) and examines the risk that screening leads to an increase in detection of latent cancer over traditional methods of detection for both breast and prostate cancer. METHODS: The present study reviews outcomes data from several large prostate and breast cancer screening trials. The natural history of latent prostate and breast cancer is then reviewed. By applying this information, the rate of latent prostate cancer detection and latent breast cancer detection with screening is compared. RESULTS: Recent large-scale prostate cancer screening studies have reported a latent cancer detection rate of 2.9% to 8.0%. This rate of detection is virtually the same as that found by traditional methods of detection. Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer that accounts for 16.2% to 23.7% of breast cancers detected in screening programs using mammography. The literature estimates that DCIS will remain latent in 50% to 66% of patients. These data suggest that the latent breast cancer detection rate in screening programs is 8.1% to 15.6%, which is a threefold to fivefold increase compared with the detection rate of latent breast cancer prior to screening with mammography. CONCLUSIONS: These results suggest that the latent prostate cancer detection rate from screening is similar to or less than the latent breast cancer detection rate from screening. Furthermore, prostate cancer screening does not appear to increase the detection rate of latent cancer over traditional methods of detection. This should eliminate concern that prostate cancer screening will lead to overtreatment of prostate cancer.

Breast Neoplasms↗
PubMed1995

Bone marrow screening: successful program.

1. Although bone marrow transplants increase the survival rate of persons with fatal blood diseases, identifying donors requires a large pool of volunteers. 2. Community involved corporations can support the Bone Marrow Donor Program by facilitating bone marrow screening in the workplace. 3. Collaboration is needed to effectively implement a bone marrow screening program at the worksite.

Bone Marrow Transplantation↗
PubMed1992

A screening mammography program. Staying alive and making it work.

The success of a mammography screening program requires thorough planning. A dependably high volume and a streamlined efficient operation are essential to survival of the program. Factors that warrant consideration prior to designing such a program include the following: Distinction between screening and diagnostic mammography examinations. Selection of a site that will meet the needs of the community and yet provide a consistently high volume. Low examination cost for screening mammography coupled with a detailed financial analysis and reappraisal on an ongoing basis. A customized marketing program that incorporates methods to increase awareness, compliance, and utilization by women and referring physicians. Well-trained, efficient, and dedicated personnel. An operation that is designed for rapid throughput and expeditious patient flow. An efficient plan for film handling, interpretation, reporting, and storage. Timely communication of examination results. A reliable mechanism for follow-up evaluation and outcome data collection. Establishment of a consistent and reliable quality assurance program and the production of high quality mammograms.

Advertising↗
PubMed2002

Large-scale randomized prostate cancer screening trials: program performances in the European Randomized Screening for Prostate Cancer trial and the Prostate, Lung, Colorectal and Ovary cancer trial.

Two large-scale randomized screening trials, the Prostate, Lung, Colorectal and Ovary (PLCO) cancer trial in the USA and the European Randomized Screening for Prostate Cancer (ERSPC) trial in Europe are currently under way, aimed at assessing whether screening reduces prostate cancer mortality. Up to the end of 1998, 102,691 men have been randomized to the intervention arm and 115,322 to the control arm (which represents 83% of the target sample size) from 7 European countries and 10 screening centers in the USA. The principal screening method at all centers is determination of serum prostate-specific antigen (PSA). The PLCO trial and some European centers use also digital rectal examination (DRE) as an ancillary screening test. In the core age group (55-69 years), 3,362 of 32,486 men screened (10%) had a serum PSA concentration of 4 ng/ml or greater, which is 1 cut-off for biopsy (performed in 84%). An additional 6% was referred for further assessment based on other criteria, with much less efficiency. Differences in PSA by country are largely attributable to the age structure of the study population. The mean age-specific PSA levels are lower in the PLCO trial (1.64 ng/ml [in the age group 55-59 years], 1.80 [60-64 years] and 2.18 [65-69 years) than in the ERSPC trial (1.28-1.71 [55-59], 1.75-2.87 [60-64] and 2.48-3.06 [65-69 years]). Detection rates at the first screen in the ERSPC trial range from 11 to 42/1,000 men screened and reflect underlying differences in incidence rates and screening procedures. In centers with consent to randomization design, adherence in the screening arm is 91%, but less than half of the men in the target population are enrolled in the trial. In population-based centers in which men were randomized prior to consent, all eligible subjects are enrolled, but only about two-thirds of the men in the intervention arm undergo screening. Considerable progress has been made in both trials. Enrollment will be completed in 2001. A substantial number of early prostate cancers have been detected. The differences between countries seem to reflect both underlying prostate cancer incidence and screening policy. The trials have the power to show definitive results in 2005-2008.

Aged↗
PubMed1987

Multipurpose Senior Service Program Deinstitutionalization Screen.

The Multipurpose Senior Services Program Deinstitutionalization Screening Instrument has been designed to identify easily and quickly those patients in nursing homes who are likely to be returned to the community through case-management efforts. The six-item screen and tables allow the interviewer to determine the probability of a patient being successfully discharged from a nursing home.

Activities of Daily Living↗
PubMed2005

[Study on health economics regarding the screening of gastric cancer in Zhuanghe high risk area].

OBJECTIVE: Using the health economics methodology to assess the screening program on gastric cancer in Zhuanghe high risk area for gastric cancer, from 2001 to 2003 and to assess the feasibility on cost of the screening program and to provide a basis for the popularization of the two-time gastric cancer screening methodology. METHODS: Three major techniques of medical economics namely cost-effective analysis (CEA), cost-benefit analysis (CBA) and cost-utility analysis (CUA) were used to assess the screening program. The screening program was composed of two steps: (1) epidemiological survey and detection of blood pepsinogen; (2) gastroscopy and biopsy of membrane. 'Number of deaths reduced' was used to evaluate the effect during cost-effective analysis while cost-benefit analysis would include the evaluation on the direct cost and indirect cost, direct benefit and indirect benefit as well as the cost-benefit ratio (CBR). During CUA, a questionnaire of WHOQOL-BREF was used to assess the value of the utility while the number of quality adjusted life year (QALY) saved by the screening program was also computed. The direct cost of per saved QALY was also calculated. RESULTS: Dada from CEA showed that: investing every 8448 Yuan on screening program and treatment in Zhuanghe high risk area of gastric cancer, one gastric cancer patient could be avoided. Results from CBA showed that: direct cost was 1,260,000 Yuan while indirect cost was 40 621 Yuan with direct benefit as 101 500 Yuan and indirect benefit as 1 540 979 Yuan. The total cost however, was 1,300,621 Yuan with total benefit as 2,555,979 Yuan and CBR was 1:1.97. Data from CUA showed that: a total number of 331.44 QALY was saved, 11.43 QALY was saved by reducing one death, 3802 Yuan per QALY was saved in high risk area of gastric cancer, through this screening program. CONCLUSION: The screening program of gastric cancer appeared to be an economic and society-beneficial measure regarding primary prevention in high risk area of gastric cancer. We also suggested that in the future, evaluations through health economics methodologies on different screening programs be carried out in the same population to solve the problem of comparability.

Adult↗